达沙替尼在伊马替尼治疗失败后的慢性期慢性髓性白血病中可诱导显著的血液学和细胞遗传学反应。
Dasatinib induces notable hematologic and cytogenetic responses in chronic-phase chronic myeloid leukemia after failure of imatinib therapy.
作者信息
Hochhaus Andreas, Kantarjian Hagop M, Baccarani Michele, Lipton Jeffrey H, Apperley Jane F, Druker Brian J, Facon Thierry, Goldberg Stuart L, Cervantes Francisco, Niederwieser Dietger, Silver Richard T, Stone Richard M, Hughes Timothy P, Muller Martin C, Ezzeddine Rana, Countouriotis Athena M, Shah Neil P
机构信息
III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
出版信息
Blood. 2007 Mar 15;109(6):2303-9. doi: 10.1182/blood-2006-09-047266. Epub 2006 Nov 30.
Although imatinib induces marked responses in patients with chronic myeloid leukemia (CML), resistance is increasingly problematic, and treatment options for imatinib-resistant or -intolerant CML are limited. Dasatinib, a novel, highly potent, oral, multitargeted kinase inhibitor of BCR-ABL and SRC family kinases, induced cytogenetic responses in a phase 1 study in imatinib-resistant or -intolerant CML and was well tolerated. Initial results are presented from a phase 2 study of 186 patients with imatinib-resistant or -intolerant chronic-phase CML (CML-CP) designed to further establish the efficacy and safety of dasatinib (70 mg twice daily). At 8-months' follow-up, dasatinib induced notable responses, with 90% and 52% of patients achieving complete hematologic and major cytogenetic responses (MCyR), respectively. Responses were long lasting: only 2% of patients achieving MCyR progressed or died. Importantly, comparable responses were achieved by patients carrying BCR-ABL mutations conferring imatinib resistance. Dasatinib also induced molecular responses, reducing BCR-ABL/ABL transcript ratios from 66% at baseline to 2.6% at 9 months. Nonhematologic adverse events were generally mild to moderate, and most cytopenias were effectively managed with dose modifications. Cross-intolerance with imatinib was not evident. To conclude, dasatinib induces notable responses in imatinib-resistant or -intolerant CML-CP, is well tolerated, and represents a promising therapeutic option for these patients. This trial was registered at www.clinicaltrials.gov as CA180013.
虽然伊马替尼可使慢性髓性白血病(CML)患者产生显著疗效,但耐药问题日益突出,且针对伊马替尼耐药或不耐受的CML患者的治疗选择有限。达沙替尼是一种新型、高效、口服、多靶点的BCR-ABL和SRC家族激酶抑制剂,在一项针对伊马替尼耐药或不耐受CML的1期研究中可诱导细胞遗传学反应,且耐受性良好。本文给出了一项针对186例伊马替尼耐药或不耐受慢性期CML(CML-CP)患者的2期研究的初步结果,该研究旨在进一步确定达沙替尼(每日两次,每次70mg)的疗效和安全性。在8个月的随访中,达沙替尼诱导了显著反应,分别有90%和52%的患者实现了完全血液学缓解和主要细胞遗传学缓解(MCyR)。反应持续时间长:仅2%实现MCyR的患者病情进展或死亡。重要的是,携带导致伊马替尼耐药的BCR-ABL突变的患者也获得了类似的反应。达沙替尼还诱导了分子反应,将BCR-ABL/ABL转录本比率从基线时的66%降至9个月时的2.6%。非血液学不良事件一般为轻至中度,大多数血细胞减少症通过调整剂量得到有效控制。与伊马替尼不存在交叉不耐受现象。总之,达沙替尼可使伊马替尼耐药或不耐受的CML-CP患者产生显著反应,耐受性良好,是这些患者一种有前景的治疗选择。该试验在www.clinicaltrials.gov上注册为CA180013。